3. Based on everything you've read , the payers putting products into the health exchanges want to market these as true , lower cost options . To get there , they will not reimburse as much as other commercial products . In fact , your best estimate is that they will pay 120% of the Medicare* reimbursement rate . If that is the case , how does your estimate of 2019 performance change ?' Is this good or bad ? You may want to answer that question from the perspective of the region as a whole* and then for each hospital . Assuming it was optional , would you recommend that St . Sebastian participate in the exchange - based products ?"